Provider Demographics
NPI:1003372764
Name:A REJUVENATING ADULT DAY HEALTH & ACTIVITIES CENTER LLC
Entity type:Organization
Organization Name:A REJUVENATING ADULT DAY HEALTH & ACTIVITIES CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:FONSECA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-246-2759
Mailing Address - Street 1:10507 MOUNT IDA
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-1737
Mailing Address - Country:US
Mailing Address - Phone:210-246-2759
Mailing Address - Fax:210-375-6092
Practice Address - Street 1:5357 W COMMERCE ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78237-1355
Practice Address - Country:US
Practice Address - Phone:210-375-6090
Practice Address - Fax:210-375-6092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-18
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care